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General NPI Number Information
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NPI Number | 1992805428
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Entity Type | Individual
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Provider Name | RAYMOND ROGER BOUCHARD LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 194 MISSILE AVENUE
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City | MINOT AFB
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State | ND
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Zip | 58705
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Country | US
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Telephone | 701-723-5527
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Fax |
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Provider Business Mailing Address
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Address Line | 755 SCOTT CIR
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City | JBPHH
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State | HI
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Zip | 96853-5399
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Country | US
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Telephone | 808-448-6377
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC5945
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License Number State | ME
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